'We're going to close our offices': Hundreds of doctors plan collective day off as Ontario rolls out new acuity payments

About 470 Ontario doctors plan to shut down their practice for several hours on April 5 so they can complete—during paid clinical hours—an online course created by the Ontario Medical Association (OMA) to explain billing for a new acuity payment model for physicians in family health organizations or networks.“The OMA has said that the (new acuity payment model) won’t mean any extra work for doctors and that the course is optional,” said Dr. Ramsey Hijazi, founder of the Ontario Union of Family Physicians, which organized the “coordinated day off” on April 5. “But you still have to complete the course to ensure you’re capturing billings appropriately. So rather than doing the course in the evening or on a weekend—without compensation—we said ‘We’re not going to do that. We’re going to close our offices and do this during clinical hours.”Dr. Hijazi declined to label the planned collective action as a protest.“I wouldn't say that,” he said. “I would say we're taking a coordinated day off to pursue continued medical education.”In an email to the Medical Post, the OMA said that while the coordinated day off is not an OMA event and the agreement between the province and its physicians does not permit action that affects patient care, "we do not believe the planned learning sessions are in violation of this framework."On April 1, Ontario’s Ministry of Health rolled out a payment model for doctors in family health organizations (FHOs) or family health networks (FHNs) that adds an extra fee for complex patients, based on a population grouper methodology created by the Canadian Institute for Health Information. Under this population grouper, patients are categorized into five bands according to their health condition—a big change from the previous model which grouped patients merely by age and gender.But the new model doesn’t mean extra money for doctors. As of April 1, doctors in family health organizations and networks will no longer receive bonuses for ensuring patients get colorectal cancer screening, mammograms, PAP smears and influenza and childhood immunizations.Read: ‘Extraordinarily insulting:’ Ontario’s new acuity payment will cost physicians more money, says family doctors unionDoctors could also lose money because of a change, implemented on April 1, that prevents them from pooling their fee-for-service limits. Instead, these limits will be applied to each individual physician.“It’s important to note this (new acuity payment model) is revenue neutral,” the OMA wrote in an earlier email to the Medical Post. “As outlined in the 2021 PSA (physician services agreement), the funds from the preventive care and FFS (fee-for-service) hard cap changes for FHO and FHN physicians will be used to undertake this initiative.”While acuity payments are a good idea, Ontario’s new model does not provide fair compensation for the extra care physicians provide to patients with complex health conditions, said Dr. Hijazi. One doctor, he noted, analyzed the fees for patients in each of the five bands and found a difference of only about 80 cents per month between the least complex and most complex patient.“The OMA actually has their own data that shows that these complex patients require up to 10 times more resources and time to manage,” said Dr. Hijazi. “So you're taking something that's requiring 10 times more time and resources to manage and you're paying an extra 80 cents a month. That just doesn't make sense, it’s actually insulting.”Read: OMA and Ontario reach deal for final year of PSATaking away preventive care bonuses and fee-for-service limits pooling adds injury to that insult, he added.“The government and the OMA should be looking at this new model they’re bringing in and finding ways to make it more feasible financially for physicians,” said Dr. Hijazi. The April 5 coordinated day off has been organized into two three-hour sessions: one with a 9 a.m. start time and another set to begin at 1 p.m. Doctors who have signed up will go through the online course at the start of their scheduled session and then join an online forum after.Read: Another open letter to the OMA board: Revisit the negotiations mandate

'We're going to close our offices': Hundreds of doctors plan collective day off as Ontario rolls out new acuity payments

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